Clinical Perspectives in Skin Changes Flashcards
What type of rash is associated with Measles?
Brick red, irregular, maculopapular
When does a measles rash appear?
How does it progress?
1) 3-4 days after onset of prodrome
2) Starts on face, moves down/out, and ends in palms and soles
What is the key pathognomonic feature of measles?
Koplik spots on buccal mucosa
What are some severe complications of measles?
Pneumonia and encephalomyelitis
What does the classic maculopapular rash look like in an adult patient with measles?
Mostly on face and neck with more sparseness to trunk
In children, erythema infectiosum is characterized by what classic appearance?
What other facial feature do we see?
There is a subsequent lacy, maculopapular, evanescent rash most commonly where?
Where is pruritus most affecting?
How is the fever?
1) Red “slapped cheek” appearance
2) Pale around mouth (Circumoral pallor)
3) Trunk and limbs
4) Palms and soles
5) Mild
What is one of the most common causes of myocarditis in childhood?
Parvovirus
Symptoms of parvovirus B19 infection can mimic those of
autoimmune states, such as?
1) SLE
2) Systemic sclerosis
3) Antiphospholipid syndrome
4) RA
What rickettsial infection causes erythematous macules, abdominal pain mimicking appendicitis, conjunctival injection, palatal petechiae, edema of dorsal hands, and calf pain?
Ehrlichiosis
Ehrlichiosis can affect what different systems?
1) Respiratory
2) Neurologic
3) Renal
4) Heart (pericarditis)
What is classic finding do we see in Lyme disease?
Erythema migrans
What occurs during stage 1 of Lyme disease?
Erythema migrans progresses into bullseye lesion
Concomitant viral-like illness develops in most Lyme disease patients and is characterized by?
Myalgia, arthralgia, headache, fatigue
What occurs during stage 2 of Lyme disease?
1) Bacteremia
2) Secondary skin lesions that are similar to primary lesions but smaller
When does the stage 2, the early disseminated infection stage occur?
When does stage 3 occur?
1) Weeks to months later
2) Months to years later
In about 4-10% of patients, how can Lyme disease affect the heart?
Myopericarditis, with atrial or ventricular arrhythmias and heart block
What is the classical manifestation that occurs in stage 3 of Lyme disease?
Arthritis of knee or other large weight-bearing joints
What is the common manifestation of EBV and may occur at any age?
Mononucleosis
What test is used for Mononucleosis?
Heterophile agglutination test (Monospot)
What are common physical findings of mononucleosis?
1) LAD especially posterior cervical chain
2) Upper lid edema (Hoagland sign)
3) Splenomegaly
What group of bacteria is syphilis in?
What is the specific bacteria that causes it?
1) Spirochete
2) Treponema pallidum
What are the primary lesions seen in the early (infectious) syphilis state?
Chancre and regional LAD
What cardiovascular disease do we see in the late syphilis stage?
Aortitis
What type of lesions are found on the skin and mucous membranes in secondary syphilis?
Condylomata lata
What Coxsackievirus infection causes stomatitis, vesicular rashes, and nail dystrophies and onychomadesis?
Hand foot mouth disease
What Coxsackievirus infection causes sudden onset fevers, headaches, myalgias, and petechiae on soft palate that ulcerate?
Herpangina
What is the hallmark of HFMD?
Development of a vesicular eruption on the palms and
soles
In HFMD, the vesicles quickly erode and form?
Yellow to gray, oval erosions
surrounded by an erythematous halo
In classic HFMD, what do nearly all patients develop that involves the tongue buccal mucosa, hard palate, and, less frequently, the oropharynx?
Enanthem
What are potential complications due to Coxsackievirus infection?
1) Pleurodynia (Bornhold dz)
2) Aseptic meningitis
3) Acute pericarditis
Measles, Rubella, Erythema infectiosum, Infectious mononucleosis, Lyme disease, and Ehrlichiosis all cause what type of rash?
Diffuse Maculopapular rash
TSS, Scarlet fever, and Erythema multiforme all cause what type of rash?
Desquamative skin changes
What is characterized by abrupt onset of fever, vomiting, watery diarrhea, and non purulent conjunctivitis?
Toxic shock syndrome
What is typical during recovery of TSS?
Desquamation especially of palms and soles
What are some physical findings associated with TSS?
1) Sunburnt appearance
2) Maculopapular rash
Scarlet fever is typically caused by?
Group A strep (pyogenes)
What is the most common cause of tonsillopharyngitis in children and adolescents?
Streptococcus pyogenes
What are some characteristics of the rash seen in scarlet fever?
1) Prominent on neck, axilla, groin
2) Circumoral pallor
3) Desquamation involves hands and feet
What key clinical feature is seen with scarlet fever?
Strawberry tongue
What is a rare cutaneous or mucocutaneous eruption
characterized by “target” lesions, predominantly on the face and extremities?
Erythema multiforme
Most cases of Erythema multiforme are related to what infections?
1) HSV
2) Mycoplasma pneumoniae
What highly contagious exanthem usually begins on the face and scalp and spreads rapidly to the trunk, with relative sparing of the extremities?
Varicella
How do the lesions of Varicella progress?
When does each occur?
1) Rose-colored macules to papules, vesicles, pustules, and crusts
2) At the same time
With varicella, when do lesions of all stages present?
At the same time
What immunoglobulin is involved with pemphigus?
IgA
What may exacerbate the painful skin lesions of pemphigus?
Exposure to UV radiation
Because PV blisters are fragile, the most common skin lesions observed in patients are?
Erosions resulting from broken blisters
Gonococcemia is caused by bacterial infection from what organism?
What the distinct characteristics of this bacteria?
1) Neisseria gonorrhoeae
2) Gram-negative, aerobic diplococci
Disseminated gonococcal infection results in a classic triad of?
1) Dermatitis
2) Migratory polyarthritis
3) Tenosynovitis
What skin findings do we see with gonococcemia?
1) Small macules
2) Hemorrhagic vesiculopustular on an erythematous base located on palms and soles
What may the skin lesions develop in gonococcemia?
Necrotic centers
Meningococcemia is caused by what bacterial infection?
Neisseria meningitidis
Disseminated meningococcal infection may present in what different ways?
1) Meningitis alone
2) Acute meningococcemia with or without meningitis
3) Chronic meningococcemia
In severe cases of meningococcemia, necrosis of the skin and underlying tissue may necessitate?
Amputation
In acute meningococcemia, what type of rash is most common?
Petechial rash on extremities
Acute meningococcemia with disseminated intravascular coagulation may produce?
Purpura fulminans
Traditionally, Thrombotic Thrombocytopenic Purpura is characterized by the pentad which consists of?
1) Microangiopathic Autoimmune Hemolytic Anemia
2) Thrombocytopenia
3) Neurologic symptoms
4) Fever
5) Renal failure
What is often required to initiate clinical TTP?
An additional inflammatory trigger (such as infection, surgery, pancreatitis, or pregnancy)
The classic form of TTP is idiopathic TTP, which is the result of a severe deficiency in?
ADAMTS13
What is the most common form of cutaneous cancer?
Basal cell carcinoma
What is the common physical presentation for basal cell carcinoma?
Umbilicated and bleeding
What is a nonhealing ulcer or a small red, conical, hard nodules nodule?
Squamous Cell Carcinoma
What is the common physical presentation for Squamous Cell Carcinoma?
Keratinization
What are mutation is a risk factor for melanoma?
p16 mutation
The back is the most common location for melanoma for which sex?
The lower extremities followed by trunk is common for which sex?
1) Men
2) Women
Which criteria of melanoma screening carries the greatest sensitivity and specificity at predicting the metastatic potential of a lesion?
Color
Palpable purpura is caused by?
Non-palpable purpura is caused by?
1) Vasculitis and infection
2) Autoimmune
What is the most common biopsy technique that is less time consuming, has good cosmetic result but is limited to processes occurring to the depth of the mid
dermis?
Shave biopsy
What technique is able to provide full thickness skin sample but may not be adequate for processes in the subcutaneous tissue due to limitations with depth?
Punch Biopsy
What technique can produce adequate sample down to the subcutaneous tissues but has longer healing time and greater potential for scarring?
Excisional Biopsy
What procedures may be used for vesiculobullous diseases for routine histology or immunofluorescence studies?
Punch or shave
What procedures may be used for lesions that are suspected to be of melanocytic origin?
Excision or punch biopsy (for small lesions)
What procedure may be used for suspected melanoma?
Avoid biopsy and refer to derm
What type of skin rash may occur from contact dermatitis?
Desquamative
